Ohio Seniors: Medicaid Crisis Planning … versus Long-Term Care Insurance?


Are you or a loved one faced with long-term care expenses? Is the cost of long-term care, nursing homes, assisted living, and home care getting to be too much?

If you are thinking about Medicaid, you should speak to an attorney who specializes in that area of law as soon as possible. There is really no time to waste—all you are wasting is money and adding stress. The sooner you get going on this, the sooner you may be eligible for Medicaid.

When we hear the word "crisis," we think of disasters or calamities of epic proportions. Well, that is where many Americans find themselves when they (or a family member) try to stay above water financially when dealing with the outrageous costs involved with senior care—especially when care facilities are involved.

Accordingly, “crisis planning” in this context is planning for those who have an imminent need for Medicaid eligibility.

What if your husband or wife has been diagnosed with amyotrophic lateral sclerosis (ALS or "Lou Gehrig's Disease") … or Parkinson's, Huntington's, or some form of dementia like Alzheimer's?

Along with the devastating news, the neurologist recommends that your spouse be placed in a nursing home today. You have no idea what this will cost, let alone how you will pay for it. In short order, you learn that Medicare will not pay, especially for the long-term. You become familiar with Medicaid but have no idea whether your spouse qualifies or even how to apply.

Before facing a situation like this, you need to discuss the Medicaid planning and application process with an experienced elder law attorney. An elder law attorney will have the necessary skills and contacts required to help you address the important issues, create a strategy, engage and direct the required healthcare staff, and work with you to get the Medicaid application approved by your state Medicaid agency.

Does Medicare cover all of the nursing home bills?

Unfortunately, no.

Medicare still remains somewhat of a mystery to most Americans, like the hypothetical couple above. Many people are under the impression that Medicare will cover all of the expenses for nursing home care.

That is not the case. The most Medicare will cover is the first 100 days and this will not be the full amount, even if you are eligible at all.

Other people believe that Medicare is only for the poor. That also is not the case. Medicare can help pay for long-term care in certain circumstances, and eligibility is not income-dependent.

So Where Does Medicaid Come In?

For most people, Medicaid only becomes an option after Medicare benefits are exhausted. But what many people don’t realize is that Medicaid benefits are not automatic. In fact, to receive Medicaid, a patient and the patient's spouse (if married) must first "spend down" their "countable" assets. In most states that limit is down to $2,000 or $999.99 for a single patient, but gets more complex for married couples. In Ohio, the asset limit for a single person is $2,000. There also are categories of assets that will be automatically exempt for purposes of qualification.

It sounds pretty easy, right? Wrong!

Actually, things can get complicated quite quickly. What do I do to protect assets? What do I do to convert assets without getting in trouble? Do I apply before or after we start getting care (and bills)?

These are all valid questions, and rather than attempting to answer them on your own with everything else that is swirling around you, you should seek professional advice from a qualified attorney who practices in Medicaid planning, understands the Medicaid system and can help you get organized for the future. If you qualify, Medicaid benefits can help pay for certain medical expenses such as:

  • Doctor and Hospital Bills;
  • Prescriptions;
  • Vision and Dental Care;
  • Medicare Premiums;
  • Nursing Home Care;
  • Personal Care Services (PCS), Medical Equipment, and Other Home Health Services;
  • In-Home Care under the Community Alternatives Program (CAP);
  • Mental Health Care; and
  • The majority of medically necessary services for children under age 21.

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